BackgroundEmbedding a Palliative Approach to Care (EPAC) is a model that helps shift the culture in long-term care (LTC) so that residents who could benefit from palliative care are identified early. Healthcare Excellence Canada supported the implementation of EPAC in seven teams from across Canada between August 2018 and September 2019.ObjectiveTo identify effective strategies for supporting the early identification of palliative care needs to improve the quality of life of residents in LTC.InterventionTraining methods on the EPAC model included a combination of face-to-face education (national and regional workshops), online learning (webinars and access to an online platform) and expert coaching. Each team adapted EPAC based on their organisational context and jurisdictional requirements for advance care planning.MeasuresTeams tracked their progress by collecting monthly data on the number of residents who died, date of their most recent goals of care (GOCs) conversation, location of death and number of emergency department (ED) transfers in the last 3 months of life. Teams also shared their implementation strategies including successes, barriers and lessons.ResultsImplementation of EPAC required leadership support and dedicated time for changing how palliative care is perceived in LTC. Based on 409 resident deaths, 89% (365) had documented GOC conversations; 78% (318) had no transfers to the ED within the last 3 months of life; and 81% (333) died at home. A monthly review of the results showed that teams were having earlier GOC conversations with residents. Teams also reported improvements in the quality of care provided to residents and their families.ConclusionEPAC was successfully adapted and adopted to the organisational contexts of homes participating in the collaborative.

An increasing body of research confirms the link between nursing variables (e.g. staffing ratios, skill mix) and patient outcomes including morbidity and mortality. This article presents the key themes that have emerged in this research and translates them into action for senior healthcare leaders. Immediate action is required in order for hospitals to effectively recruit and retain nurses, and to provide high quality patient care that minimizes risk.

On accumule de plus en plus de preuves confirmant le lien qui existe entre les variables des soins infirmiers (par ex., taux de dotation, compétence collective) et les résultats pour les patients, y compris la morbidité et la mortalité. Cet article présente les grands thèmes qui sont ressortis de cette recherche et les traduit en mesures concrètes pour les hauts dirigeants des soins de santé. Une intervention immédiate s'impose afin que les hôpitaux puissent recruter efficacement et garder du personnel infirmier, et pour fournir aux patients des soins de haute qualité qui réduise le risque au minimum.

in the pelvis were deeply stained. The uterus was normal and healthy ; a director easily passed into its cavity. The tumors were given to Dr. R, H. Filz, who was kind enough to examine them, and the following is his description of them :-" Papilloma of both ovaries ; the one forming a mass of the volume of the two fists, the other somewhat smaller. Both soft, cauliflower-like, the surface made up of villi, easily separated from each other, covered with a somewhat viscid substance, resembling the white of an egg. The larger mass was reddish-gray in color, moderately translucent ; the smaller is of pale-yellow color, and opaque. Tho first presented merely a confused collection of villi, attached to a small, dense, fibrous base ; while the smaller contained one or more cysts, from the interior of which groups of villi projected. Under the microscope, tho villi were seen to bo simple and compound, covered with a layer of